Evaluation of the Interplay between HIV and COVID-19 in a large urban safety-net HIV clinic

大型城市安全网 HIV 诊所中 HIV 和 COVID-19 之间相互作用的评估

• 批准号: 10169797
• 负责人: Monica Gandhi
• 金额: $ 70.98万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10169797
• 关键词: 2019-nCoV; Adherence; Africa; Age; Alcohol or Other Drugs use; Anti-Retroviral Agents; Antibody Response; Anxiety; Area; Attenuated; COVID-19; COVID-19 pandemic; Cardiovascular Diseases; Caring; Cessation of life; Chronic Disease; Cities; Clinic; Clinical; Clinical Investigator; Communicable Diseases; Communities; Country; Data; Diabetes Mellitus; Disease; Disease Outbreaks; Ebola; Emergency department visit; Enrollment; Epidemic; Epidemiologist; Evaluation; Fibrinogen; Frequencies; Future; Grant; HIV; HIV Infections; Health; Health system; Healthcare; Healthcare Systems; Height; High Prevalence; Hospitalization; Housing; Human immunodeficiency virus test; Hypertension; Immune response; Immunity; Impairment; Incidence; Individual; Infection; Inpatients; Intervention; Laboratories; Link; Logistics; Low income; Lung; Lung diseases; Measures; Medical; Mental Depression; Mental disorders; Methods; Neighborhoods; Occupational Health; Outcome; Patients; Persons; Pharmaceutical Preparations; Population; Predisposition; Prevalence; Procedures; Prospective cohort; Protease Inhibitor; Provider; Public Health; Pulmonary function tests; RNA; Regimen; Registries; Reporting; Research; Research Infrastructure; Risk; Risk Factors; San Francisco; Schools; Scientist; Services; Severity of illness; Shelter facility; Site; Social Behavior; Social Distance; Social Work; Social isolation; Social support; Spanish flu; Speed; Stress; Support System; System; T cell response; T-Lymphocyte; Telephone; Tenofovir; United States; Viral; Viral Load result; Virus; Visit; Vulnerable Populations; aging population; antiretroviral therapy; base; care systems; co-infection; cohort; comorbidity; coronavirus disease; experience; food insecurity; health care service utilization; immune activation; infection rate; infection risk; insight; marginally housed; novel; pandemic disease; pandemic influenza; public health emergency; public health relevance; resilience; response; safety net; sex; social stigma; testing services; therapeutic development; transmission process; urgent care; vaccine development; virology; ward

PROJECT SUMMARY/ ABSTRACT An unprecedented public health emergency due to the COVID-19 pandemic is unfolding worldwide and the United States has been the epicenter of the pandemic since March 26, 2020. No prior global pandemic of this scale has overlapped temporally with the HIV pandemic. Despite this, given the breathtaking speed at which the pandemic has progressed, very little is known about the interplay between HIV and SARS-CoV-2 given that COVID-19 has only recently entered areas of high HIV prevalence. The COVID-19 pandemic is threatening worldwide gains in UNAIDS 90:90:90 targets for HIV by disrupting health systems, economies, and the health of people with HIV. San Francisco was the first city in the U.S. to impose “shelter in place” public health measures on March 16, 2020. Given the need to limit in-person visits to counter the spread of COVID-19, research on the impact on HIV outcomes, retention in care, and sociobehavioral outcomes will be crucial to develop interventions to attenuate COVID-19's deleterious impact and to plan for future pandemics. Whether people with HIV (PWH) are more or less susceptible to COVID-19 or severe disease is unknown; some of the risk factors for severe COVID-19 (older age, cardiovascular disease, pulmonary disease) are more prevalent among PWH but HIV medications such as tenofovir and its metabolites could be protective. PWH in low-income settings have marginal housing and food insecurity, increasing transmission risk. Given the impact of HIV on immune responses, it is also important to understand if PWH will have less durable immunity against COVID-19 following infection. Finally, the impact of the COVID-19's disruption of medical and social services for PWH needs urgent study, both during the crisis and in its aftermath, since COVID-19 has the potential to eradicate the progress made on Ending the HIV Epidemic to date. This proposal will answer three vital questions concerning the interplay between the two viruses. The site of the study will be at the Ward 86 HIV Clinic, a large safety-net clinic for publicly-insured patients with HIV in San Francisco, near the neighborhoods experiencing concentrated COVID-19 epidemics. Aim 1 will provide novel, urgently needed insights into how SARS-CoV-2 infection risk, prevalence and clinical outcomes vary by HIV status and/or antiretroviral regimen (i.e. tenofovir). Aim 2 will explore whether HIV infection will impair humoral or T-cell responses to COVID-19, providing insights for therapeutic and vaccine development. Aim 3 data will evaluate the impact of disruption of healthcare and social support systems on PWH, including viral suppression; retention in care; hospitalizations, co-morbidity outcomes, and non-COVID-19 related death; healthcare utilization during COVID019; and socio-behavioral outcomes during and after social distancing to assess isolation, food insecurity, stress, substance use, stigma, and resilience. Harnessing, the research infrastructure of the UCFAR, citywide COVID-19 registries, and a large, aging population of PWH served by the Ward 86 clinic, this grant will put immediate, high-impact studies in place to track the colliding pandemics.

项目摘要/摘要 由于19号大流行而引起的空前的公共卫生紧急情况正在全球展开， 自2020年3月26日以来，美国一直是大流行的中心。 该量表已暂时与HIV大流行重叠。尽管如此，考虑到令人惊叹的速度 大流行的发展，对艾滋病毒和sars-cov-2之间的相互作用知之甚少 鉴于Covid-19最近才进入高艾滋病毒患病率的地区。 COVID-19大流行是 威胁全球在UNAID中的收益90:90:90艾滋病毒的目标是破坏卫生系统，经济和 艾滋病毒患者的健康。旧金山是美国第一个强加“庇护所”的城市 公共卫生措施于2020年3月16日进行。鉴于需要限制面对面的访问以应对 COVID-19，对艾滋病毒结果的影响，保留护理和社会性结果的研究将是 对于制定干预措施至关重要，以减轻Covid-19的有害影响并计划未来的大流行。 艾滋病毒（PWH）的人或多或少容易受到19日的影响或严重疾病； 严重的共同199（年龄较大，心血管疾病，肺部疾病）的一些危险因素更多 在PWH中普遍存在，但可以保护替诺福韦及其代谢产物等HIV药物。 pwh in 低收入环境具有边际住房和粮食不安全，增加了传播风险。鉴于影响 艾滋病毒对免疫反应的艾滋病毒，也必须了解PWH是否具有较不耐用的免疫力 感染后的Covid-19。最后，Covid-19对医疗和社会服务的中断的影响 对于PWH，需要紧急研究，无论是在危机还是在其后果中，由于Covid-19有可能 消除结束艾滋病毒流行的进展。 该提案将回答有关两种病毒之间相互作用的三个重要问题。 该研究的部位将在Ward 86 HIV诊所举行，这是一个大型安全网诊所，适用于公开保险的HIV患者 在旧金山附近，经历着集中的Covid-19情节。 AIM 1将提供 新颖的，迫切需要深入了解SARS-COV-2感染的风险，患病率和临床结果如何因 HIV状态和/或抗逆转录病毒方案（即Tenofovir）。 AIM 2将探讨艾滋病毒感染是否会损害 对Covid-19的体液或T细胞反应，为治疗和疫苗发育提供了见解。目标3 数据将评估医疗保健和社会支持系统破坏对PWH的影响，包括病毒 抑制;保留护理；住院治疗，合并症结果和非旋转19相关死亡； COVID019期间的医疗保健利用；和社会疏远期间和之后的社会行为成果 评估隔离，粮食不安全，压力，药物使用，污名和韧性。利用，研究 UCFAR的基础设施，全市COVID-19登记处，以及大量老龄化的PWH人口 该赠款将立即进行高大影响的研究，以追踪碰撞的大流行系统。